Abstracts

Rationale: Transportation is critical to all aspects of life including employment, socialization, recreation, and self-esteem. Restricting driving privileges for PWE limits personal and social independence and negatively impacts overall quality of life. We sought to characterize patient knowledge of the driving laws, emotional reactions, and compliance with restrictions. Methods: A 12-question survey was delivered to 287 consecutive patients in a prospective fashion between 11/08-2/09 in a tertiary care epilepsy clinic. We excluded 51 surveys in total (28 due to incompleteness, 12 for lack of gender/age information, 6 indicated they did not have seizures, and 5 had another chronic neurological disease). Participation was voluntary, and anonymity was preserved. Written informed consent was obtained following disclosure. The survey format included basic demographics and survey questions that addressed basic knowledge of the law, emotional responses, compliance, and current driving status. Responses included yes-no and multiple choices. Only surveys that contained responses for age and gender were included to adequately stratify the results. Surveys which were incomplete or indicated an alternative primary neurological disease were excluded. Results: 236 patients (61% female; 82.6% Caucasian) were surveyed with a mean age of 41.7 years were included and analyzed. 83.5% were on 1-2 AEDs, and 52.6% had their first seizure < 20 years of age. 26.7% reportedly no valid license (47.6% never, 42.9% expired, 9.5% revoked). The main reaction to driving restriction was reported as sadness in 30.9%, anger (24.2%), isolation (17.8%), denial (15.3%), fear, (10.6%), and relief in 5.9%. 83 (35.2%) were eligible to drive yet only 77.1% were actually driving, and 147 (62.3%) were not eligible yet 23.8% were driving despite having seizures in the last 6 months (Chi square 61.5; p=<0.0001). Of those driving with reported seizures, most were women and most reported “driving wherever I need to go”. However, the initial emotional response to knowing the driving restriction was “I will not drive until my doctor or DMV says it is okay because I may hurt someone else”. Only 53.0% of patient responses correctly identified the correct legal requirements for PWE in the state of Florida (p=0.07). Of those who did not, the majority felt that a period of abstinence longer than 6 months was required or that restriction depended upon the individual seizure type. Despite verbalized understanding at the initial visit, 173 (73.3%) patients acknowledged receiving information. Additionally, 20.8% denied being informed despite being given detailed verbal information and of these patients 59.2% did not know the law and 10.2% did not respond to the question. Conclusions: In our cohort, about ½ of PWE know the driving laws and < 3/4 recall receiving information. Almost 1/4th of eligible patients do not drive and 1/4th of ineligible do so. The patient’s response to driving restriction is most commonly sadness though most are concerned about hurting other people. Promoting patient awareness may be helped by repeated explanation of the laws and written educational material.